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. 2022 Nov;20(6):867-880.
doi: 10.1007/s40258-022-00741-0. Epub 2022 Aug 8.

Cost-Effectiveness Analysis of Stockholm 3 Testing Compared to PSA as the Primary Blood Test in the Prostate Cancer Diagnostic Pathway: A Decision Tree Approach

Bettina Wulff Risør  1   2   3 , Nasrin Tayyari Dehbarez  4   5 , Jacob Fredsøe  6   7 , Karina Dalsgaard Sørensen  6   7 , Bodil Ginnerup Pedersen  7   8
Affiliations

Cost-Effectiveness Analysis of Stockholm 3 Testing Compared to PSA as the Primary Blood Test in the Prostate Cancer Diagnostic Pathway: A Decision Tree Approach

Bettina Wulff Risør et al. Appl Health Econ Health Policy. 2022 Nov.

Abstract

Objective: This study evaluated the cost effectiveness of using Stockholm 3 (STHLM3) testing compared to the prostate-specific antigen (PSA) test in the diagnostic pathway for prostate cancer.

Methods: We created a decision tree model for PSA (current standard) and STHLM3 (new alternative). Cost effectiveness was evaluated in a hypothetical cohort of male individuals aged 50-69 years. The study applied a Danish hospital perspective with a time frame restricted to the prostate cancer diagnostic pathway, beginning with the initial PSA/STHLM3 test, and ending with biopsy and histopathological diagnosis. Estimated values from the decision-analytical model were used to calculate the incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the base-case analysis.

Results: The model-based analysis revealed that STHLM3 testing was more effective than the PSA, but also more costly, with an incremental cost-effectiveness ratio of €511.7 (95% credible interval, 359.9-674.3) for each additional correctly classified individual. In the deterministic sensitivity analysis, variations in the cost of STHLM3 had the greatest influence on the incremental cost-effectiveness ratio. In the probabilistic sensitivity analysis, all iterations were positioned in the north-east quadrant of the incremental cost-effectiveness scatterplot. At a willingness to pay of €700 for an additional correctly classified individual, STHLM3 had a 100% probability of being cost effective.

Conclusions: Compared to the PSA test as the initial testing modality in the prostate cancer diagnostic workup, STHLM3 testing showed improved incremental effectiveness, however, at additional costs. The results were sensitive to the cost of the STHLM3 test; therefore, a lower cost of the STHLM3 test would improve its cost effectiveness compared with PSA tests.

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Figures

Fig. 1
Fig. 1
Decision tree illustrating the compared diagnostic pathways of prostate cancer. ISUP International Society of Urological Pathology, MRI magnetic resonance imaging, PI-RADS Prostate Imaging Reporting and Data System, PSA Prostate-Specific Antigen, STHLM3 Stockholm 3
Fig. 2
Fig. 2
Tornado diagram of the deterministic sensitivity analysis. Bar colors: blue indicates lower incremental cost-effectiveness ratio (ICER); red indicates higher ICER. EV expected value, MRI magnetic resonance imaging, PCa prostate cancer, PSA prostate-specific antigen, STHLM3 Stockholm 3
Fig. 3
Fig. 3
Incremental cost effectiveness of Stockholm 3 (STHLM3) compared to prostate-specific antigen (PSA)
Fig. 4
Fig. 4
Cost-effectiveness acceptability curve. PSA prostate-specific antigen, STHLM3 Stockholm 3
See this image and copyright information in PMC

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References

    1. NORCAN. Prediction: tables. 2021. https://nordcan.iarc.fr/en/dataviz/predictions_tables?cancers=240&map_vi.... Accessed 23 Nov 2021.
    1. Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Zappa M, Nelen V, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384(9959):2027–2035. - PMC - PubMed
    1. Gronberg H, Adolfsson J, Aly M, Nordstrom T, Wiklund P, Brandberg Y, et al. Prostate cancer screening in men aged 50–69 years (STHLM3): a prospective population-based diagnostic study. Lancet Oncol. 2015;16(16):1667–1676. - PubMed
    1. Gronberg H, Eklund M, Picker W, Aly M, Jaderling F, Adolfsson J, et al. Prostate cancer diagnostics using a combination of the Stockholm3 blood test and multiparametric magnetic resonance imaging. Eur Urol. 2018;74(6):722–728. - PubMed
    1. Stattin P, Carlsson S, Holmstrom B, Vickers A, Hugosson J, Lilja H, et al. Prostate cancer mortality in areas with high and low prostate cancer incidence. J Natl Cancer Inst. 2014;106(3):dju007. - PMC - PubMed

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